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Allowing To Die

John F. Morris, Ph.D. Rockhurst University

Seminar in Medical Ethics PL 4700

Allowing To Die

I. Allowing to Die

A. Definition: allowing a fatal pathology to take its natural course when there is no moral obligation to prolong life.

Allowing To Die

1) Futile Treatment: when treatment offers little or no reasonable, "medical" hope of restoring a patient to health, there is no moral obligation to continue providing it. a) This is a professional judgment to be rendered by the health care team.

Allowing To Die

2) Grave Burden: when treatment imposes a grave burden on the patient, there is no moral obligation to continue. a) This is a subjective judgment made by the patient/family/proxy.

Allowing To Die

B. Basic Care vs. Medical Therapy

1) Basic Care: actions that respect the value and dignity of human persons.

a) For example: keeping a patient comfortable, clean, and pain-free.

Allowing To Die

b) The big debate today centers around the issue of what counts as basic care?

Does this include artificial nutrition & hydration?

Allowing To Die

2) Medical Therapy: technological interventions aimed at restoring a patient's health.

Allowing To Die

3) In the presence of a fatal pathology, the moral obligation to provide medical therapies begins to decrease.

a) But our obligations to the patient as a person do not cease!

Allowing To Die Basic care must always be provided to patients out of Respect for Persons.

Allowing To Die

b) In addition, effective therapy that will circumvent the fatal pathology (often indefinitely) is considered life-prolonging, and should be continued. But this is not obligatory, especially when the treatment causes a grave burden.

Allowing To Die

c) It is also permissible to continue with futile treatment for a time, especially to meet the patient's other basic human needs (psychological/social/spiritual). (1) However, futile therapy need not be continued indefinitely, but may be withheld or withdrawn.

Allowing To Die

C. Withholding vs. Withdrawing treatment 1) Although there is a difference between these two concepts medically speaking, they are not significant to the ethical debate.

Allowing To Die

a) Either it is permissible to withdraw or withhold treatment, or it is not. b) Nor is the issue of "how long" before death ensues relevant.

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2) The key issue is whether there is an obligation to provide medical treatment?

a) Can we restore the person's health? b) Will the person be able to pursue the purpose of life?

Allowing To Die

D. In conclusion, when one withholds or withdraws life-support, the cause of death is not resisted because there is no moral obligation to circumvent death any longer.

Allowing To Die Allowing to die does not violate the principle of non-malevolence because the source of the harm is the fatal pathology in the patient.

Allowing To Die

Summary: Is a fatal pathology present in the patient? Does resisting the fatal pathology involve effective or ineffective therapy? If the therapy is effective, does the therapy impose a grave or excessive burden? What is the intention of the persons who withdraw or withhold life support?

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